Thomas Kitwood's Person-Centered Care: A Better Approach in Dementia

Thomas Kitwood's Person-Centered Care Can Improve Quality of Life in Dementia
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What Is Person-Centered Care?

The development of the person-centered care approach is widely attributed to professor Thomas Kitwood in the late 1980s at the University of Bradford in the United Kingdom. Person-centered care is a way of providing care to people in which the unique person and their preferences are emphasized, instead of the disease, its expected symptoms and challenges, and the lost abilities of the person.

Person-centered care recognizes that dementia is only a diagnosis of the person, and that there is much more to the person than her diagnosis.

A person-centered approach changes how we understand and respond to challenging behaviors in dementia. Person-centered care looks at behaviors as a way for the person with dementia to communicate his needs, and understands that figuring out what unmet need is causing the behaviors is the key.

Person-centered care also encourages and empowers the caregiver to understand the person with dementia as having personal beliefs, remaining abilities, life experiences and relationships that are important to them and contribute to who they are as a person.

On a moment-by-moment basis, person-centered care strives to see the world through the eyes of the particular person with dementia.

How Does Person-Centered Care Differ from the Traditional Medical Model of Care?

Let's take the example of George:

George is an 89 year-old male with Alzheimer's disease who one week ago was moved to a nursing home because his wife Hilda just couldn't keep caring for him at home. Hilda visits George every day and although she wishes she could have kept him at home, she knows that George needed more care than she could give him.

  • Medical Approach

A strictly medical approach will be almost solely concerned with how much of his breakfast George ate, getting George to meet his goal of walking 50 feet in the hallway today, and accomplishing his shower today at 9am because it's his assigned day. When he tries to sit down after walking only 10 feet, a caregiver using the medical approach asks for a second caregiver to help on the other side of George and they stand George back up again and begin to move him forward, despite his pleas of being too tired. George then becomes frustrated and pushes the caregivers away.

Despite George's resistance, these duties and tasks are checked off the to-do list.

  • Person-Centered Approach

A person-centered, more holistic approach, might look more like this:

Rather than approaching George with a list in our heads, person-centered care looks at the person first, and the goals and tasks second.

Instead of serving the same breakfast to everyone, a person-centered approach would find out from George or Hilda what George's usual breakfast was before he moved to the nursing home.

A person-centered caregiver would also encourage the 50 feet of walking, but if George is tired and resistant when she tries to walk with him, she will try again later in the day. The person-centered caregiver might also have learned that George much prefers taking a bath instead of a shower, and that his routine was a hot bath before bedtime; therefore, his bath time will have been shifted to 9pm.

Not surprisingly, the day goes quite well for both George and his caregiver.

Benefits of Person-Centered Care

Person-centered care has been shown by multiple research studies to be effective in reducing challenging behaviors in people with dementia. One experimental study used trained staff members to implement person-centered care approaches with nursing home residents who had dementia. The results? Inpatient hospitalizations- which sometimes result if challenging behaviors are not able to be safely handled in a care facility- and the use of psychotropic medications -which can be somewhat effective but also can have serious side effects- were both significantly reduced.

Another study involving 289 nursing home residents at 15 different sites demonstrated reduced levels of agitation in people with dementia when a person-centered care approach was utilized.

Person-centered care can reduce caregivers' frustrations and save money by reducing hospitalizations and the use of medications, but more importantly, it provides a better quality of life for persons with dementia and their loved ones.

It's also very likely how you and I would want to be treated.

Sources:

Alzheimer's Disease Association. Person Centered Care. Accessed November 14, 2013. http://www.alz.org.sg/about-dementia/person-centered-care

Alzheimer's Society. Person-centered care. Accessed November 14, 2013.  http://www.alzheimers.org.uk/site/scripts/services_info.php?serviceID=167

The Canadian Alzheimer Disease Review. April 2003. Person-centered Dementia Care: A Vision to be Refined. http://www.livingdementia.com/downloads/newsletters/2010/sep_oct/person-centered_dementia_care.pdf

The Lancet Neurology, Volume 8, Issue 4, Pages 317 - 325, April 2009. Caring for Aged Dementia Care Resident Study (CADRES) of person-centered care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial. http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2809%2970045-6/fulltext

The National Care Forum. Statement of Best Practice; Key Principles of Person-Centered Dementia Care.

US Department of Health and Human Services. Agency for Healthcare Research and Quality. September 25, 2013. Person-Centered Care for Residents with Dementia Exhibiting Aggressive Behavior Reduces Psychiatric Hospitalizations and Behavior-Related Medications.

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